Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $812.83 / $1,288.25	Facility		$724.44	$812.83	$1,288.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $660.69 / $870.96	Professional		$467.74	$660.69	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $1,445.44	Professional		$812.83	$812.83	$1,445.44
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $1,445.44 / $2,951.21	Facility		$1,380.38	$1,445.44	$2,951.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $776.25 / $1,737.80	Professional		$645.65	$776.25	$1,737.80
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,148.15 / $1,148.15	Professional		$1,148.15	$1,148.15	$1,148.15
CareSource Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $831.76 / $1,318.26	Facility		$549.54	$831.76	$1,318.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,000.00 / $1,479.11	Professional		$724.44	$1,000.00	$1,479.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $776.25 / $776.25	Facility		$776.25	$776.25	$776.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $562.34 / $776.25	Professional		$562.34	$562.34	$776.25
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $776.25 / $1,513.56	Facility		$776.25	$776.25	$1,513.56
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $562.34 / $776.25	Professional		$562.34	$562.34	$776.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,047.13 / $1,513.56	Professional		$741.31	$1,047.13	$1,513.56
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Facility		$1,659.59	$1,659.59	$1,659.59
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,548.82 / $2,818.38	Professional		$1,380.38	$1,548.82	$2,818.38
United Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $575.44 / $1,202.26	Facility		$436.52	$575.44	$1,202.26
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $616.60 / $870.96	Professional		$389.05	$616.60	$870.96